EVALUATING THE CLINICAL OUTCOMES IN PATIENTS ADMITTED FROM EMERGENCY DEPARTMENT WITH ALTERED SENSORIUM

Abstract

Background: 

Altered sensorium is a common and critical presentation in the emergency department (ED), associated with diverse etiologies and high morbidity. This study aimed to profile the clinical characteristics, management, and outcomes of adult patients admitted with acute altered mental status.

Methods: 

A prospective observational cohort study was conducted in CMH Quetta over six months, enrolling 150 consecutive adult patients admitted from the ED with acute altered sensorium. Data on demographics, etiology, interventions, and outcomes were collected. Primary outcomes were in-hospital mortality and functional status at discharge.

Results: 

The mean age of participants was 58.4 ± 17.2 years, with 56% male predominance. The most common etiologies were metabolic derangements (30%), sepsis/infection (24%), and stroke (20%). Overall, 28% required ICU admission, 25.3% required mechanical ventilation, and the in-hospital mortality rate was 14.7%. Poor functional outcome (modified Rankin Scale 3–5) was observed in 43% of patients. Multivariable analysis identified age ≥65 years (aOR 1.9, 95% CI 1.1–4.2), Glasgow Coma Scale (GCS) ≤8 on admission (aOR 3.8, 95% CI 1.9–7.6), sepsis (aOR 2.5, 95% CI 1.2–5.1), and need for mechanical ventilation (aOR 4.4, 95% CI 2.1–9.0) as independent predictors of in-hospital mortality.

Conclusion: 

Altered sensorium in ED admissions is frequently due to metabolic, infectious, and cerebrovascular causes and carries significant mortality and disability. Early recognition of high-risk features—particularly severe consciousness impairment, sepsis, and respiratory failure—is essential to guide prompt diagnostic evaluation, targeted treatment, and intensive care, which may improve outcomes in this vulnerable population.